How to build a mindfulness program in your ED

Mindfulness is a polarising concept for many of those who work in health.

Mindfulness is espoused by some as a modality for promoting individual and workplace wellness. Indeed, there is a growing body of hard scientific evidence that mindfulness practice can have a beneficial effect on both wellness and performance.  The key articles are outlined in How to Build a Wellness Program Part II [link]. Mindfulness can have anatomical and physiological effects. There is additional evidence that group practice of mindfulness enhances team performance [2].

However, if implementation of a mindfulness programme is not carefully and thoughtfully considered, the concept can alienate many of your staff.

They may feel that mindfulness is being used ‘by management’ as a panacea to address all workplace ailments. Some can feel that the department or organisation is “compensating” for system failures by imposing the burden of another ‘tick box exercise’. Mindfulness can also often be misunderstood and misrepresented by those who deliver the content, as well as those who receive it.

So, for this How To, Dr Braganza and the team at WRaP EM, would like to share with you the lessons we have learned in building mindfulness-based programmes where we work. This includes  the recommendations and tips based on the experience gained from implementing the oneED mindfulness-based program at Gold Coast Health Emergency Departments [1].

Tips and Recommendations

(1) Performance focus

Healthcare professionals, especially those in critical care, aim for a highly efficient team environment. Therefore they are arguably more invested and therefore more open to participating in a program that may optimise performance than one that ‘improves wellness’.  Via its ability to improve focused attention and awareness, mindfulness has been demonstrated to enhance both technical and non-technical aspects of clinical care.

(2) Embedded and inclusive practice

Mindfulness practice doesn’t have to be one hour of meditation in a dark quiet space – a near impossible task in any of our EDs! It can be a simple, brief and low-intensity activity. This allows it to be embedded into the midst of a busy, chaotic environment.

Believe it or not, it is possible in our fast-paced ED environment, to encourage staff to recognise and exploit transient opportunities for a ‘pause and reset’ during any shift.  Examples include ‘Brain Break’  flyers posted next to blood gas and urinalysis machines [link], inviting staff to use the 30-second enforced pause required for sample testing, Other examples include use of the square/tactical breath while washing hands prior to arrival of a resus patient, or while waiting for a software program to open.

square breathing

Attribution: http://www.myhealingpath.com/page/490971592

The above practices do not require staff to leave the work area – in fact quite the opposite. The practice does not become “one more thing to get done”. Of note, as these events occur in a shared clinical space, the practice is available to all ED staff.

(3) Low-intensity practice

Care must be taken to keep practices un-intrusive, comfortable and optional. Concern has been raised over some predisposed individuals inadvertently experiencing distress when tapping into deep conscious awareness, when led by inexperienced mindfulness trainers [3]. oneED is led by non-experts in mindfulness. As such, we exercise caution to keep activity simple and ‘light”. Material for activity is typically sourced and distributed at Gold Coast Health by Dr Braganza, but co-champions are encouraged to initiate their own ideas and themes.

(4) Fluid open-mindedness about practice

Australian mindfulness expert, GP and academic, Dr Craig Hassed, recommends that with any mindfulness programme, one must try to be faithful to the philosophy, but flexible in the form.

Strictly speaking, mindfulness is primarily based on developing a better sense of conscious awareness, ‘living in that moment’, if you will. However, success, sustainability and “scale” of a mindfulness program relies on some agility and flexibility with respect to content and mode of delivery.

At Gold Coast Health, all staff were encouraged to take the ethos of the “4-minute pause” and adapt it to what felt relevant and valuable. As a result, they converted “pause” to “pump” and “meditation” to Macarena. Consistent with the aim of encouraging staff to pay attention to an activity without distraction, and with the added benefit of forming connection between staff members –who can do the Macarena and keep from smiling and boogying along with your colleagues J

WRaP EM suggests that the wellness method is important, but what is more important is the statement that is intended: that we value wellness and connection as a department.

A video of such a practice has been publicised on Gold Coast Health’s facebook page:

https://www.facebook.com/GCHealth/videos/1431287573673981/

5) Engage co-leaders

Invite, encourage and facilitate all staff to lead mindfulness practice. This provides fresh perspectives and shared ownership.

For Gold Coast Health’s four-minute pause in medical handover, commentary has been given by a range of emergency physicians and trainees who have variably talked about tactical breathing, gratitude, and looking for rainbows. Nursing leads have also made commentary, guided meditations, and coordinated group dance, as outlined above.

(6) Leverage

We have leveraged “the big names” in Emergency Medicine to promote the value of mindfulness in clinical performance. Examples include Scott Weingart [Weingart, S. Kettlebells for the Brain. 2016  [Available from: https://emcrit.org/emcrit/kettlebells-brain/ and https://soundcloud.com/academic-life-in-em/wellness-practicing-mindfulness-scott-weingart, as well as Mike Lauria and colleagues [4].

(7) Consistency and perseverance

Like any new ED strategy, mindfulness practice takes a long time to become habituated into the workplace. Endorsement by leadership is vital.

In the words of Gold Coast Health’s Deputy Director, Dr David Spain: “The morning we think we don’t have time to pause because it’s too busy, is the morning we need it the most

(8) Celebrate wins

Earlier this year, Gold Coast Health announced that the winner of its  inaugural Staff Wellness and Safety Awards was the oneED program. The receipt of this award not only underlined the value of the program, but garnered significant positive publicity for the health service. The program is now being explored at a wider organisational level including in other departments and as part of the Magnet program.

https://www.linkedin.com/feed/update/urn:li:activity:6434962571710861312/

https://www.facebook.com/GCHealth/videos/1783056898415348/

  1. Braganza, S., A. Markwell, and S. Jayasekara, Wellness, resilience and performance: Translating ideas into action. Emergency Medicine Australasia, 2018. 30(2): p. 263-265.
  2. Yu, L. and M. Zellmer-Bruhn, Introducing team mindfulness and considering its safeguard role against conflict transformation and social undermining. Academy of Management Journal, 2018. 61(1): p. 324-347.
  3. Derbyshire, D., Should we be mindful of mindfulness, in The Observer. 2014.
  4. Lauria, M.J., et al., Psychological Skills to Improve Emergency Care Providers’ Performance Under Stress. Annals of Emergency Medicine, 2017. 70(6): p. 884-890.